The sunshine vitamin

Sunlight is our main source of vitamin D but with short winter days in particular, we risk our 'daily dose' falling short of the recommended levels. Additionally, with only 10% of the recommended daily amount found naturally in food there may be justification in fortifying more foods with vitamin D; a view supported by Professor Mitch Blair, from the Royal College of Paediatrics and Child Health. The clearest indication of deficiency is the increase in hospital admissions due to rickets over the last 15 years. Currently the Government's Healthy Start programme offers vitamins free for people on income support but it seems that the uptake level is low. Perhaps low-cost supplements available to all would be the answer, added to a dose of public knowledge of the need?

Scotland's health inequalities - 50 years on

Audit Scotland's Report out this week acknowledges that over the past 50 years there have been some improvements in Scotland's health inequalities but there is still a very long way to go. It's not surprising that the worst health problems are linked with deprived areas. Deputy Scottish Conservative leader Jackson Carlaw says that people, regardless of their background, have to take responsibility for their own health, but also calls on ministers to do more. See the BBC news item for comments on the results of the report. 

Earlier HIV testing needed

Groups at high-risk of HIV are encouraged to test more regularly in order to reduce the worrying rise in the spread of infection. Fear and and lack of understanding surrounding both HIV and HIV testing in the UK continue to put the population at higher risk than necessary. Latest UK statistics sourced from the Health Protection Agency reveal that a quarter of people living with HIV in the UK are unaware of their condition.

                                                                                              

Alcohol - The Cost and the Price

Measures proposed to deal with alcohol-related crime and disorder in the UK are given in the Home Office press release of 29th November. Included in the proposal is 'Minimum Unit Pricing'.
Plans in Scotland for MUP have met with opposition from the European Commission as a "disproportionate" response to Scotland's health problems. Health Secretary Alex Neil will be Speaking in Brussels today to argue the case for the Scottish government remaining committed to introducing minimum alcohol pricing. Speaking before his visit today Mr Neil said: "The point that I will make in Brussels is that minimum pricing can and will save lives.

Poverty 2012

The Joseph Rowntree Foundation's annual Poverty and Social Exclusion report is just out.  This offers an early analysis of the current government's policies on poverty and social exclusion as well as providing some evidence on the effects of recent welfare reform.  One area of concern the report higlights is underemployment: of the 64. million people lacking the paid work they want, 1.4 million are in part-time work.  Figures from ONS also underline this problem: they report a 47% increase in underemployment since the economic downturn in 2008.  A BBC report quotes Andrew Sissons of the Work Foundation, who notes that "of the half-a-million new jobs created in the UK in the past two years, about 70% have been part-time."

Direction of travel

What is the relationship between UK government policy on tackling health inequalities and the available research?  Not quite what we think, according to a paper published by the Socialist Health Association.  Its author reviews research and policy between 1997 and 2007, finding that, rather than being strictly evidence-based, policy in England and Scotland has rather been shaped around the transmission of research-based ideas. A similarly ambivalent approach to the use of the evidence base appears in an article published in the Journal of Epidemiology and Community Health.  Interviews with policy makers in six countries provides an insight into how they view barriers to and facilitators of the use of RCTs for social programmes.

On aggregate

While the proportion of the English population engaging in 3 or 4 key "unhealthy behaviours" (smoking, alcohol consumption, poor diet, limited physical activity) has decreased in recent years (down from 33% in 2003 to 25% in 2008), the focus of this improvement is amongst richer, better educated people.  Those with no educational qualifications are far more likely to engage in all four behaviours and this tendency has increased over time, with the result that the poorest and least well educated have seen no improvement and relative inequalities have increased.  The King's Fund takes data from the Health Survey for England between 2003 and 2008 to examine how health behaviours cluster, arguing that focus on individual health behaviours, while helpful, is not the solution: a more holistic approach is necessary.

Measure up

A review published in the BMJ takes a look at the measures used in reporting health inequalities.  It finds that most studies use relative measures of effect rather than absolute, which, as the study's authors point out "may influence readers’ judgments of the magnitude, direction, significance, and implications of reported health inequalities."  It should be noted that the review is a bit of a straw poll, as it only covered one year's worth of research in 10 leading medical, pulic health and epidemiology journals.

Could do better

A major review for the WHO published in the Lancet maps health inequalities in the 53 states of the WHO European region.  Commissioned to support development of the WHO's new health policy framework for Europe, Health 2020, the review highlights substantial variations between and within states.  Lead author, Professor Sir Michael Marmot stressed the importance of attending to the issue:  "health inequality needs to be one of the main criteria by which we assess the effectiveness of countries’ health systems, and the effectiveness of government as a whole."

Home, sweet home

The September issue of the Journal of Epidemiology and Community Health includes some articles on the relationship between housing and ill-health.  One study considers the effect of cumulative exposure to housing affordability stress and its association with poorer mental health, while another looks at the impact of housing improvement on common childhood illnesses amongst Indigenous Australian communities.  A new report from the UK Department for Communities and Local Government (DCLG) assesses routes for preventing homelessness.  Making Every Contact Count sets out nine "local challenges," including limiting use of bed and breakfast accomodation (especially for young people and families), adopting a No Second Night Out model and offering a housing options prevention service.  Supporting this strategy there is an evidence review on the cost of homelessness;  DCLG has also released current statistics on homelessness prevention and relief.

Hit or miss?

Giving evidence before the Commons Education Select Committee, Alan Milburn, the government's preferred candidate for chair of the soon-to-be Child Poverty and Social Mobility Commission, suggested that there was not "snowball's chance in hell" of meeting the 2020 target for eradicating child poverty in the UK.  The conversation also included some interesting discussion about how far reducing child poverty and enhancing social mobility were competing claims.  Childhood socio-economic disadvantage has regularly been linked with obesity but does social mobility have any significant health effects in this regard.  A study from the USA looks at family income trajectories and their association with obesity in adolescence. Elsewhere, a survey of current policy and practice considers the role of maternal employment in tackling poverty and promoting social mobility.

Not making it bettter

A brief study in the Journal of Epidemiology and Community Health aims to discover from systematic review evidence what kinds of public health interventions actually increase health inequalities, by providing disproportionate benefit to less disadvantaged groups.  The researchers conclude that media campaigns and workplace smoking interventions appear to increase inequalities, while structural workplace interventions and fiscal interventions, such as tobacco pricing, appear to reduce inequalities.

Soft option

The latest edition of Public Health Nutrition features several studies on soft drink consumption, along with an editiorial that echoes the recent fighting talk about fizzy drinks: Making soft drinks the dietary version of the cigarette.  One study, from the University of Alberta, examines pre-school children's consumption of soft drinks, finding that socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. No surprises there, then.  A recent study from the University of Bangor has been much commented on: Adaptive metabolic response to 4 weeks of sugar-sweetened beverage consumption in healthy, lightly active individuals and chronic high glucose availability in primary human myotubes has been translated into "fizzy drinks are evil" by the press (Daily Mail article, of course).

Target practice

Pulse reports that CCGs in deprived areas will have their commissioning outcomes framework targets adjusted according to the demographics of their populations.  NICE intends to level the playing field, promising a  ‘robust approach to case mix adjustment.'  HSJ focuses on lobbying around the Advisory Committee on Resource Allocation (ACRA)'s interim proposals for setting public health budgets for councils.

Time travel

US blog Decisions Based on Evidence highlights some research from the States on differences in life expectancy on the basis of ethnicity and educational achievement.  The summary puts it starkly: “Despite advances in health care and increases in life expectancy overall, Americans with less than a high school education have life expectancies similar to adults in the 1950s and 1960s."  The study's authors conclude: "The message for policy makers is clear: implement educational enhancements at young, middle, and older ages for people of all races, to reduce the large gap in health and longevity that persists today."

Not so fast

Mining data from the Born in Bradford cohort, researchers examine the relationship between proximity to fast food outlets, deprivation, obesity and ethnicity.  They found that the South Asian women in the study had greater access to fast food outlets but were less likely to be obese (17% with BMI > 30 as compared with 24% amongst non-South Asian women).  The study calls into question the usual assumption that area level deprivation and density of fast food outlets are strongly linked to obesity: other factors are at play, too.  Another UK based study attempts to make some connections between ethnicity density, neighbourhood food and physical activity environments.

Putting healthcare on the spot

Does healthcare help everyone equally? A study from Finland examines socioeconomic equity in amenable mortality (premature deaths that should not occur if effective healthcare is provided).  Researchers, who analysed data from 1992 to 2008, found that the decreasing trend in amenable mortality was notably slower in low income groups.  When comparing the effectiveness of specialist and primary care in reducing inequalities, it was clear that inequities were larger and increased faster in deaths amenable to specialist care, although "primary health care interventions made a greater contribution to overall inequity."  Another study examined mortality data from 14 European countries, assessing whether socioeconomic inequalities in amenable mortality reflected access to or quality of healthcare (neither, was the verdict).  A paper in the European Journal of Health Economics does the math, comparing avoidable mortality with healthcare spending in 14 western countries between 1996 and 2006.

The long view

Analysis of ethnic group differences in self-reported limiting long term illness maps the changing situation in the UK population during the 1990s.  While all ethnic groups reported a higher prevalence in 2001 than in 1991, the rise was largest amongst the White Irish, Pakistani and Bangladeshi groups.  Early analysis of data from the GP Patient Survey, which for the first time included health-related quality of life questions, reveals significant geographical and socioeconomic variation, particularly as regards long term conditions.

Trouble shooting

Louise Casey's report for  the Department of Communities and Local Government, Listening to Troubled Families,  suggests above all that long term problems need long term solutions.  Based on interviews with 16 such families, Louise Casey stresses that "the traditional approach of services reaching individual family members, at crisis point or after, and trying to fix single issues such as 'drug use', 'non-attendance at school' or 'domestic violence' in these families is most often destined to fail."  In this way it endorses the government's commitment to Family Intervention Projects and to the payment by results Troubled Families Programme.  Critics of the approach, such as those who contributed  a recent BMJ editorial, suggest that evidence for the effectiveness of Family Intervention Projects is poor, however.

Culturally aware?

A review of interventions to increase takeup of breast and cervical cancer screening amongst Asian women takes a look at what works, finding that there's no quick fix, although a combination of multiple strategies, such as cultural awareness training for healthcare staff and use of outreach workers, is most effective.  There was little evidence for cost effectiveness or long-term sustainability of any of the programmes.  Another review assesses interventions to improve patient participation in the cancer treatment process for culturally and linguistically diverse groups.

What are the chances?

A team from Cardiff University assesses the state of learning on the association between social inequality and infant health, covering adverse birth events, low birth weight, premature birth, stillbirth, neonatal mortality and post-neonatal mortality.  In all of these categories, there is a clear association between deprivation and poor outcomes: only failure to thrive shows no evidence of association.  Latest ONS (Office for National Statistics) figures on births and deaths in England and Wales show a small rise in stillbirths, along with a rising fertility rate and a continuance of the trend of rising average age of mothers, now at 29.7 years.  Age-standardised mortality rates in 2011 were the lowest ever recorded for England and Wales, at 6,172 deaths per million population for males and 4,402 deaths per million population for females.  More detail in infant mortality (this time for 2009) is also provided by ONS in the Birth Cohort Tables.  This release caught the media's attention, particularly as regards the higher early death risk in multiple births ("twins are five times more likely to  die before their first birthday").  NHS Choices Behind the Headlines site separates the data from the terror and also puts some more alarming figures under the spotlight.  The ONS analysis also shows that mothers aged under 20 have the highest infant mortality rate for both single and multiple births and that the infant mortality rate for mothers born outside of the UK was greater than for UK born mothers.  Meanwhile, first data from the 2011 census shows the largest ever population for England and Wales at 56.1 million;  an animated data visualisation maps the changes over the past century.

5 a day

How effective are targeted schemes to improve access to fruit and vegetables for deprived populations? A study from Norfolk evaluates the effectiveness of a mobile fruit and vegetable store, selling cost-price produce in targeted communities.  This intervention succeeded in its basic aim of improving fruit and vegetable consumption in the areas, but it was a small scale study (255 users).  A study from Australia examines perceptions of affordability and availability of fruit and vegetables amongst women in deprived areas.

The heart of the matter

Coronary heart disease (CHD) mortality in England fell by about 6% every year between 2000 and 2007, yet inequalities between socioeconomic groups widened during this period.  A study published in PLOS Medicine tries to assess the reasons behind this development, concluding that trends in major risk factors for CHD, which vary considerably by socioeconomic group, are the root of the inequality.  While medical treatment has made a major contribution to lowering mortality, this effort is undercut by the effects of rising BMI and diabetes prevalence, particularly marked in lower socioeconomic groups.  A study from the Netherlands looks at how far inequalities in mortality from acute myocardial infarction (AMI) persist amongst the elderly. 

How to do well

Home-based provision of welfare rights advice to economically disadvantaged older people is being trialled in the North east of England in the Do-Well study.  In this qualitative study, participants will be recruited from general practice registers.  Research from Denmark looks at the effectiveness of a preventive home visit programme for older people, finding that although takeup by people from lower socioeconomic groups was less good, more proactive invitation could improve this.  Data from the Uppsala Birth Cohort Study is used to consider the impact of mid-life income and retirement income on mortality.

End of life care

A study from Belgium looks at disparities in end of life decision making, finding that patient inclusion in decision making decreases with age.  End of Life Care Profiles by PCT and local authority are in England have been produced by South West Public Health Observatory for the National End of Life Care Intelligence Network.

On the map

NHS Right Care puts variations in healthcare provision for diabetes and kidney disease under the mapping microscope in two new atlases of variation.  As well as the printed text, there's an online interactive version.  NHS Kidney Care has also published a survey of the evidence base on health inequalities in kidney disease and care amongst adults.

Join Professor Steve Field and others in DH's health inequalities and inclusion webinar on Thursday 7 June 11.30am – 12.30pm.

Best laid plans

Soon after its planning policy for travellers sites was published, the Department for Communities and Local Government has issued a progress report on tackling inequalities amongst gypsies and travellers. Children and Young People Now casts a critical over its provisions as regards education. A report from the Council of Europe considers this population’s experiences within a human rights framework.

School to work

Charlie Taylor, the Government’s Expert Advisor on Behaviour, was asked last autumn by the Education Secretary to review policy on school attendance. His report has now been published and highlights the evidence that children who have had poor school attendance are more likely to be not in employment, education or training (NEET) after leaving school. While trends in attendance continue to improve, there is still a significant minority who regularly do not attend and truancy is not the only reason for this. A paper from the Joseph Rowntree Foundation asks whether changing aspirations and attitudes amongst parents and children can improve educational attainment, finding that the emphasis should rather be on keeping aspirations on track. From the employment side of the NEET question, a discussion paper from the Chartered Institute of Personnel and Development (CIPD) promotes innovation in engaging employers in tackling youth unemployment. A report from the Work Foundation also highlights the difficulties faced by NEETs: Lost in transition stresses that transition into work for young people is becoming increasingly difficult. The Government’s social mobility advisor, Alan Milburn, has reported on progress towards fair access to professional careers, indicating that there’s still considerable room for improvement.

Out in the cold

Quality in Ageing and Older Adults features a group of articles on inequalities amongst older people in Ireland.  These include studies on the relationship between age and social exclusion in rural areas, the effects of recession on older people in Northern Ireland and the Republic and the relationship between cold housing and health and wellbeing.  A survey for Age UK found that "the number of older people owing money has risen sharply over the last year."  The latest figures on fuel poverty from the Department of Energy and Climate change recently reported a fall in numbers of households in fuel poverty for 2010, but predicted a rise for subsequent years.

Leaves on the line

Ahead of the (now noticeably delayed) Government reponse to the Dilnot report on social care funding, the Centre for Social Justice argues that ministers should clearly prioritize the needs of the poorest elderly people.  Richard Humphires, writing for the King's Fund blog, anticipates the content of the forthcoming social care White Paper (due out by the end of May but also likely to be delayed), in the light of the challenging message about funding offered by Dilnot.

Value judgements

The Journal of Health Organization and Management devotes an issue to the question of social values in health care decision-making, the idea that health priorities are set not merely by clinical and economic criteria, but also by social value judgements.  Amongst the highlights is an article that examines the role of social values in NICE's priority-setting and decisions.  There's also a study of the relationship between social values and health priority setting in Germany.

Map of Europe

A study from the European Health Observatory analyses the complex relationship between health systems, health and wealth.  It considers the latest data on cost pressures on health systems in an unclement economic climate and assesses the economic costs of ill-health in Europe.  The paper also looks at the economic argument for public health interventions and the effectiveness of policies and interventions to reduce health inequalities.  A European survey of access to healthcare for vulnerable groups by Medecins du Monde (MdM) reports data drawn from MdM centres in Brussels, Amsterdam, London, Munich and Nice.  Primary concerns are lack of access to primary healthcare, antenatal care and vaccinations for destitute EU nationals as well as migrants and asylum seekers.

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Nice neighbourhood?

A working paper published by the UK Healthy Cities programme surveys the state of knowledge on the relationship between the physical urban environment and health inequalities, covering transport, housing, green space, crime and land use mix. A study of community dwelling older people in Scotland looks at the impact of neighbourhood deprivation on self-perceived quality of life, while another considers whether neighbourhood has an effect on the participation of older people with chronic conditions in daily activities.

Keep active

A review of physical activity programmes targeted at disadvantaged populations concluded that multi-component group-cased programmes were effective for adults, although not for children. Community-wide interventions tended to produce small improvements in physical activity. However, there was only limited evidence for the effectiveness of interventions aimed at hard to reach groups. Those programmes that had some kind of theoretical underpinning tended to work better, as did those that combined physical activity with education and social support. A study from the US offers a meta-analysis of behaviour and health outcomes for physical activity interventions amongst healthy ethnic minority adults. An article in the European Journal of Public Health examines the economic appraisal behind NICE's guidance on environmental interventions to promote physical activity.

Inequality is catching

Data from New Zealand suggest that there are socioeconomic inequalities in the burden of serious infectious disease. The study looked at hospital admissions for infectious and non-infectious disease and found clear ethnic and socioeconomic disparities in infectious disease risk. Results, showing that admissions for infectious disease increased over the period studied, also call into question the theory that in developed societies the health burden shifts towards chronic disease. A study of socioeconomic inequalities in mortality from pandemic influenza in England during the 2009 outbreak shows a similar bias towards poorer populations, with people in the most deprived quintile being three times more likely to die. Some other studies take a look at inequalities in the uptake of influenza vaccines amongst the general population in the US , at risk groups the UK and amongst dementia sufferers in England and Wales.

Born in Bradford

Mining data from the Born in Bradford cohort study, a team from the University of Leeds assesses how the association between maternal mental health and infant growth differs between ethnic groups. A study of women in the north west of England considers the effects of prenatal depression on infant outcomes amongst British Pakistani women. Another output from Born in Bradford tests the diagnostic accuracy of case-finding questions to identify perinatal depression. Finally, a team from the University of York's Mother and Infant Research Unit uses qualitative data to tailor public health messages about breastfeeding to meet the needs of British Bangladeshi women.

Place matters

Diabetes is signficantly more prevalent amongst the poorest in the population than the richest. A handful of recent studies examine how the disease affects people in more deprived neighbourhoods. From the US the SEARCH for diabetes in Youth study looks at prevalence of type 1 diabetes amongst young people. Research from Sweden assesses incidence of coronary heart disease amongst people with diabetes. The Diabetes Study of Northern California (DISTANCE) takes a look at the association between neighbourhood deprivation and cardiometabolic risk factors amongst adults with diabetes. Work carried out by the Centre for Primary Care and Public Health at St Barts in London considered ethnic differences in glycaemic control amongst people with type 2 diabetes.

Deprivation and death

People who live in deprived areas are more likely to die in hospital than those living in affluent areas, a report from the National End of Life Intelligence Care Network (NEoLCIN) shows. As other research has demonstrated recently, numbers of people dying at home have continued to rise. And surveys continue to report a preference for dying at home. Authors of the NEoLCIN report stress that the variation is not entirely connected with cause of death or progression of illness: access to care is also important. The report also considers variations in age and cause of death, demonstrating that people in the most deprived quintile of the population are more likely to die before the age of 65 and from respiratory illness or smoking related cancers.

It's your age

Implementation of those sections of the Equality Act 2010 that ban age discrimination in provision of services has been delayed. This aspect of the Act, which covers health services amongst others, was due to come into force on 1 April 2012, but will now take effect in October this year at the earliest. Meanwhile a report from DH on the impact of patient age on decision-making in oncology warns that "clinicians may over rely on chronological age" rather than pay attention to other factors, such as frailty or co-morbidities. A Europe-wide study on successful ageing notes that health in later life may have a strong connection with socioeconomic conditions in childhood.

No smoke

The good news (picked up by the media) is that smoke free legislation seems to have impacted positively on pregnancy complications. A new study documents the fall in numbers of pre-term deliveries and small for gestational age babies in Scotland since the smoking ban. Women and Health includes a systematic review of smoking cessation interventions that target women. A couple of studies on the relationship between smoking and socioeconomic status consider the importance of the disadvantaged smoker and the efficacy of interventions to reduce smoking-related inequalities.

On the map

Credit reference company Experian maps UK deprivation by local authority area, looking at risk of poverty, "financial exclusion" and long term unemployment as well as current conditions.

Incredible or grumpy?

The Department for Education (DfE) has published interim results from its trials of two parenting interventions, the Incredible Years and Supporting Parents with Kids (SPOKES) as part of the Helping Children Achieve study. There is also a paper on what the study has found about how parenting style influences child anti-social behaviour. Another DfE study, the High Need Families project, reports on developing and implementing a new parenting programme, the Helping Families programme, designed for families where there are children with severe and persistent conduct problems. A recent issue of Pulse includes rather more anecdotal evidence of outcomes from a parent and toddler group, beautifully named "grumpy mums". Community Practitioner includes an evaluation of the Strengthening Families programme, a family intervention aimed at improving school engagement and academic success in children aged 10-14.

Risky business

The Joseph Rowntree Foundation publishes a review on the perception and management of risk amongst users of adult social care services. This updates the review of research done for DH published in 2007 by the Social Policy Research Unit. There's a focus on the functioning of recent measures to mitigate risk, such as the POVA list and CRB checks, although thus far evidence for their effectiveness is limited. The report also notes that there is still little research on the experience of Black and Minority Ethnic communities as regards adult social care. A systematic review and meta-analysis of observational studies on the prevalence and risk of violence against adults with disabilities concludes that although it's clear that this group is at increased risk of violence, the quality of evidence is patchy. An article in the British Journal of Learning Disabilities evaluates an intervention to increase uptake of eye tests (offered as part of annual health checks) by people with learning disabilities.

Access all areas?

A round-up of studies that take a look at inequalities of access in a range of healthcare contexts:
A brief article in Public Health considers the effect of distance on the most socially deprived communities access to dental care in North East England. Access to and use of home healthcare services are found not to be affected by socio-economic status in a scoping review. There's a qualitative study of women's experience of antenatal care in the North West of England, particularly focusing on vulnerable groups. Finally, a study in Social Science and Medicine examines the role of education and income in socioeconomic inequalities in waiting times for elective surgery.

Parent power

The Incredible Years parenting programme has been much studied: added to the literature is a two-year follow-up evaluation. The European Journal of Developmental Psychology alliteratively devotes its February issue to evidence-based parenting programmes to promote positive parenting. Highlights include a review of FAST (Families and Schools Together), as used in the UK, US, Holland and Germany, which has a good track record for retaining low income families. Also there's a paper looking at the use of parenting programmes to address child maltreatment along with an account of a study that considers how far parenting programmes aimed at improving a child's life chances should address literacy as well as child behaviour.

Indicators

Marmot local authority indicators for 2012 are now out. Two years on from the publication of the Marmot review, it seems that inequalities have widened between wealthiest and most deprived areas even while life expectancy continues to improve. As the man says, "while indicators show improvements in many areas, this is not the time to start celebrating."

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In my car

Fresh Start is the Welsh Assembly Government's health promotion campaign designed to reduce smoking in cars where children are present. Last year the BMA recommended legislating on the matter, although was shouted down by the press for overstating levels of risk. A study in Tobacco Control attempts to measure children's exposure to secondhand smoke during a typical car journey. The tendency for smoking cessation interventions to target parents via their children is put under the microscope in a meta-analysis and systematic review.

Downward trend

Age UK suggests that there is a crisis in social care funding for older people. Along with expressing this concern about reduced funding from local authorities and DH, Age UK is also anticipating the White Paper on social care, due to be published in the spring. Thus the report encourages the government to take up recommendations from the Law Commission report on social care legislative reform and the Dilnot report on funding for social care.

Can we afford to eat well?

Does healthy eating mean a bigger food bill, asks a study in the British Journal of General Practice (BJGP). Based on a diet diaries from children aged 5-16 attending childhood obesity clinics in primary and acute care, researchers compared the cost of current diet with a diet based on the Eatwell Plate, when purchased in budget and mid-range supermarkets, as well as high street purchase. The healthy diet was more expensive in all three contexts, although only marginally so. However, a poor diet based on purchase from a budget supermarket remained the cheapest option and thus could present a barrier to the most disadvantaged families. This issue of BJGP also includes a simulation study on counselling patients on dietary behaviour change and a feasibility study on transferring childhood obesity clinics from acute to primary care. Public health professionals and policy-makers from Victoria, Australia reflect on the experience of funding and managing community based obesity prevention initiatives.

On the move

A high level of residential mobility is typical of families with young children, research based on the UK Millennium Cohort Study finds and mobile families tend to be disadvantaged in socio-economic and health terms. Although for most families this means a move into a less deprived area than their original circumstances, for the minority of families that move into more deprived areas health outcomes are significantly worse and this impacts on health inequalities between areas with different levels of deprivation. A similar study mines data from the West of Scotland Twenty-07 Study to assess health impacts from childhood mobility in late adolescence and adulthood.

You know, for kids ...

DH has announced the setting up of an expert panel to develop a strategy to improve care for children and young people. The Children and Young People's Forum, to be modelled on the NHS Future Forum, will be jointly chaired by Professor Ian Lewis (Medical Director at Alder Hey NHS Foundation Trust) and Christian Lenehan (of the Council for Disabled Children). Data from the Generation R Study is examined to assess how far prenatal, perinatal and postnatal factors affect socioeconomic inequalities in childhood asthma. The UK Millennium Cohort Study is mined for evidence for the impact of home environment on inequalities in unintentional injury in early childhood. Researchers found that housing quality and safety equipment use did not explain socioeconomic inequalities in injuries.

The first cut...

What are the early indications from the local authority budget cuts since 2010? A report from the Joseph Rowntree Foundation sifts through the evidence, looking in particular at how far local authorities are meeting the needs of the most deprived communities, how services are being redesigned or more closely targeted and what kinds of change lie ahead.

Maternity matters

A review of determinants of late or inadequate use of antenatal healthcare found that late booking was associated with the usual suspects, including low income, high levels of unemployment and smoking status. With this in mind, some research into using Trust databases to identify predictors of late booking in antenatal care could also be useful. A report from the stillbirth and neonatal death charity Sands presses for urgent improvements in UK antenatal care. SANDS echoes the findings from last year's Lancet stillbirths series, which highlighted the UK's poor record compared with other developed countries on this matter. The latest issue of Seminars in Perinatology focuses on maternal deaths and includes a review of the UK confidential enquiries into maternal deaths.

Mapping tobacco use

Local tobacco control profiles for England 2011 are now online. Newly included is data relating to smoking prevalence overall and also in the routine and manual workers group. A study from the University of Nottingham looks at who receives prescriptions for smoking cessation medication (including nicotine replacement therapy, varenicline and bupropion). Analysing general practice data from the Health Improvement Network Database, researchers found that patients with COPD or depression were more likely to be given smoking cessation prescriptions, while younger and otherwise healthy individuals were least likely to receive them. Younger healthy individuals in the form of adolescents are the subject of a longitudinal social network analysis that seeks to map changes in friendship selection and smoking behaviour amongst British teenagers.

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Changes

There's an increasing wealth of research and policy output on behaviour change in public health: a timely review of grey literature (material generated by government, or business, industry or academic communites but not published commercially) offers a useful survey. A paper from the US looks at ways to improve public health through interventions targeted at specific places (including schools, neighbourhoods, restaurants or recreational areas). Finally, a review of public health interventions delivered to whole communities assesses effectiveness, particularly in terms of impact on inequalities and also cost.

Home truths

Following the publication of the Government's housing strategy, the Housing Learning and Improvement Network (LIN) has produced a toolkit to help local authorities and public and private sector developers in their approach to housing for older people. Housing LIN has also produced an evaluation of the Extra Care Housing Fund, concluding that such schemes can improve older people's health and wellbeing and offer a viable cost-effective alternative to residential care. A paper from Sunderland City Council looks at about providing reablement or intermediate care accommodation within an extra care housing scheme. A briefing from the NHS Mental Health Confederation considers the role of housing in mental health and wellbeing. And finally another paper from the Housing LIN examines the evidence base for early intervention in housing.

Weighing up the matter

There's a useful systematic review of the literature on the relationship between socioeconomic inequalities and adult obesity in BMC Public Health. The National Obesity Observatory also gathers together the data and evidence on socioeconomic status and adult and child obesity. The BERTIE project (Babies and Early Years Risk - Trying to Implement the Evidence) aimed to develop a simple evidence based means to identify babies at risk of later obesity. The study found that parental obesity, weight centile, infant weight gain and smoking in pregnancy are the most important factors. Tower Hamlets Healthy Borough Programme documents its progress towards tackling the social and environmental causes of obesity in the area.

Mapping child poverty

The End Child Poverty campaign has published a (widely reported) map of child poverty in the UK. Levels are mapped by local authority area and (for maximum impact) parliamentary constituency. The Joseph Rowntree Foundation's annual monitoring poverty and social exclusion report makes for equally uncomfortable reading, noting a rise in fuel poverty and homelessness, as well as unemployment and underemployment. In a speech last month former Labour MP and now government advisor on social mobility and child poverty, Alan Milburn, predicted a rise in child poverty rates.

Migrant health

The Health Protection Agency (HPA)'s second report on migrant health notes that a small proportion of the UK's migrant population bears "the greatest burden of infectious disease reported in the UK". The report emphasises the important role primary care practitioners play in early identification of infectious diseases. Repeating the message from the previous baseline report, the HPA calls for primary care to ensure access to culturally competent and language supported services. A recent study of participation in a cervical screening programme by Polish, Slovak and Romanian women in London confirms this need for language support.

Cancer update

A study from the Cancer Research UK Cancer Survival Group asks how many cancer deaths in England would be avoided if socioeconomic inequalities were eliminated? Based on data covering 1996-2006, the researchers conclude that while avoidable deaths have reduced, the gap between rich and poor remains substantial: "over 60% of the total number of avoidable deaths occurred within six months after diagnosis and approximately 70% occurred in the two most deprived groups." Latest data from ONS (up to 2009) confirms the persistence in geographic inequalities in survival, with the north-south divide reduced but still in evidence. A more detailed study of socioeconomic inequalities in survival from breast cancer in South West England looks at whether inequalities are present in screening-detected cancer as well as in symptomatic women. The researchers found inequalities with screening detected diagnosis, but in a less marked way. Research on cancer spending amongst primary care organisations in South East England suggests spending was not so much associated with disease burden than activity: "Lower per capita spending on cancer was associated with smaller PCT populations and a higher proportion of deprived areas within them." Finally, a major study from Cancer Research UK examines causes of cancer in the UK in 2010: lifestyle appears to be a major culprit, accounting for over 40% of cancers diagnosed.

Family circle

Working with troubled families is a target area for current government policy. The Department for Education has published a report on family interventions, an intensive, multi-agency approach to tackling anti-social behaviour, worklessness and intergenerational disadvantage. An evaluation of the Parenting Early Intervention Pathfinder compares the effectiveness of 3 parenting programmes over a 2 year period. This large scale trial involved families over 18 local authorities, using the Incredible Years, Triple P and Strengthening Families Strengthening Communities programmes. A study published in BMC Health Services Research models the cost-effectiveness of parenting programmes designed to prevent conduct disorder.